Editor-in-Chief: Kenneth D. Candido, MD
BACKGROUND: Pudendal neuralgia is a debilitating pain syndrome, and finding long-lasting treatment modalities has been challenging in pain management. Sacral nerve stimulation (SNS) has emerged as a treatment option for pudendal neuralgia but the correct placement of SNS leads can be challenging. Previously described techniques include placing the stimulator at the conus, as well as retrograde and transforaminal approaches.
OBJECTIVE: We aim to describe the relevant anatomy and technique for precise SNS lead placement using a sacrococcygeal approach.
STUDY DESIGN: A technical report.
SETTING: An interventional pain management practice.
METHODS: Description with accompanying fluoroscopic and anatomical images; this technical report describes the specific technique we employed in 7 patients suffering from intractable pelvic pain as a result of pudendal neuralgia.
RESULTS: Successful placement of percutaneous SNS leads using a sacrococcygeal approach in all 7 patients suffering from pudendal neuralgia. Six of the 7 patients experienced a decrease in the visual analog scale (VAS) pain score (> 50%), improvement in function during the trial period, and proceeded with permanent neurosurgical implantation. Four out of 6 patients that underwent permanent implantation reported persistent pain relief and improvement in the activities of daily living at long-term follow-up (range: 12–33 months).
LIMITATIONS: The design of this study limits the ability to determine the definitive risks, potential complications, and long-term benefits. The precise clinical value of this approach remains to be determined in larger prospective studies.
CONCLUSIONS: Although infrequently performed, the sacrococcygeal approach may represent a more successful and safe alternative method for the placement of SNS leads for a SNS trial.
Key words: Technical note, neuromodulation, sacral nerve stimulation, pudendal neuralgia, pelvic pain, SCS, SNS